Posterior circulation CVA and the HINTS exam

Today in ICU report we heard about a case of posterior fossa CVA unfortunately resulting in brain death and transition to comfort care.

One of the most challenging clinical questions in the emergency room is how to differentiate central vs peripheral causes of vertigo. This is especially challenging when a patient has existing gait abnormalities and a previous diagnosis of BPV.

One prediction tool is the HINTS exam. This was studied in a cross-sectional study of patients who presented with acute vestibular syndrome (hours or days of persistent vertigo/dizziness, nystagmus, nausea or vomiting, head motion intolerance, new gait unsteadiness).